<?php echo $this->element('menu'); ?>
<div class="worthlessShares form" style="width:1650px;">
		<?php echo $this->element('ws_menu'); ?>
    <?php echo"<b>Line No: </b>".$this->data['WorthlessShare']['LineNo'];?>
    <?php echo"<br><b>Order No: </b>".$this->data['WorthlessShare']['OrderNo'];?>
    <?php echo"<br><b>CommonID: </b>".$this->data['WorthlessShare']['CommonID'];?>
   <br><hr>
<?php echo $this->Form->create('WorthlessShare');
	echo $this->Form->input('LineNo');
	?>

	<?php
		
		/*echo $this->Form->input('CommonID',array('type'=>'hidden'));
		echo $this->Form->input('CCName',array('type'=>'hidden'));
		echo $this->Form->input('CCNumber',array('type'=>'hidden'));
		echo $this->Form->input('CCExpiry',array('type'=>'hidden'));
		echo $this->Form->input('CCVerif',array('type'=>'hidden'));
		echo $this->Form->input('CCType',array('type'=>'hidden'));		
		echo $this->Form->input('Gross',array('type'=>'hidden'));
		echo $this->Form->input('GST',array('type'=>'hidden'));		
		echo $this->Form->input('parcelNumber',array('type'=>'hidden'));
		echo $this->Form->input('docfile',array('type'=>'hidden'));
		echo $this->Form->input('bankAuthorisationNumber',array('type'=>'hidden'));*/
	?>
	<table style="width:50%">
			<tr>
				<td><b>Date</b></td><td><?php echo $this->Form->input('Date',array('type'=>'text','label'=>false,'div'=>false,'value'=>date("Y-m-d H:i:s",$this->data['WorthlessShare']['CommonID'])));?></td>
				<td><b>Company</b></td><td><?php echo $this->Form->input('CompanyName',array('label'=>false,'div'=>false));?></td>
				<td><b>Client</b></td><td><?php  echo $this->Form->input('RegdName1',array('div'=>false));
										echo $this->Form->input('RegdName2',array('div'=>false));
										echo $this->Form->input('RegdName3',array('div'=>false));
										echo $this->Form->input('RegdName4',array('div'=>false));
										echo $this->Form->input('RegdName5',array('div'=>false));?>
								</td>
			</tr>
			<tr>
				<td><b>Line No</b></td><td><?php echo $this->data['WorthlessShare']['LineNo'];?></td>
				<td><b>Code</b></td><td><?php echo $this->Form->input('CompanyCode',array('label'=>false,'div'=>false));?></td>
				<td><b>RegdAd</b></td><td><?php
										echo $this->Form->input('RegdAd1',array('div'=>false));
										echo $this->Form->input('RegdAd2',array('div'=>false));
										echo $this->Form->input('RegdAd3',array('div'=>false));
										echo $this->Form->input('RegdAd4',array('div'=>false));
										echo $this->Form->input('RegdAd5',array('div'=>false));?>
									</td>
			</tr>
			<tr>
				<td><b>Order</b></td><td><?php echo $this->Form->input('OrderNo',array('label'=>false,'div'=>false));?></td>
				<td><b>Number</b></td><td><?php echo $this->Form->input('NumFigures',array('label'=>false,'div'=>false));?></td>
				<td><b>Number in Words</b></td><td><?php echo $this->Form->input('NumWords',array('label'=>false,'div'=>false));?></td>
			</tr>
			<tr>
				<td><b>Docs Recd</b></td><td><?php echo $this->Form->input('DateDocRecd',array('label'=>false,'div'=>false));?></td>
			    <td><b>Security</b></td><td><?php echo $this->Form->input('Security',array('label'=>false,'div'=>false));?></td>
				<td><b>New Ad</b></td><td><?php echo $this->Form->input('NewAd1',array('div'=>false));
									echo $this->Form->input('NewAd2',array('div'=>false));
									echo $this->Form->input('NewAd3',array('div'=>false));
									echo $this->Form->input('NewAd4',array('div'=>false));
									echo $this->Form->input('NewAd5',array('div'=>false));?>
								</td>
			</tr>
			<tr>
				<td><b>For rego</b></td><td><?php echo $this->Form->input('DateForRego',array('label'=>false,'div'=>false));?></td>
				<td><b>SRN</b></td><td><?php echo $this->Form->input('SRN',array('label'=>false,'div'=>false));?></td>
				<td><b>Email</b></td><td><?php echo $this->Form->input('Email',array('label'=>false,'div'=>false));?></td>
			</tr>
			<tr>
				<td><b>Regd</b></td><td><?php echo $this->Form->input('Registry',array('label'=>false,'div'=>false));?></td>
				<td><b>HIN</b></td><td><?php echo $this->Form->input('HIN',array('label'=>false,'div'=>false));?></td>
				<td><b>Tel</b></td><td><?php echo $this->Form->input('Tel',array('label'=>false,'div'=>false));?></td>
			</tr>
			<tr>
				<td></td><td></td>
				<td><b>Broker</b></td><td><?php echo $this->Form->input('BrokerNameAdd',array('label'=>false,'div'=>false));?></td>
				<td><b>Amount</b></td><td><?php echo $this->Form->input('AmtRecd',array('label'=>false,'div'=>false));?></td>
			</tr>
			<tr>
				<td><b>Action</b></td><td><?php echo $this->Form->input('Action',array('label'=>false,'div'=>false));?></td>
				<td><b>Convert</b></td><td><?php echo $this->Form->input('DateForConv',array('label'=>false,'div'=>false));?></td>
				<td><b>Status</b></td><td><?php echo $this->Form->input('Status',array('label'=>false,'div'=>false));?></td>
			</tr>
			<tr>
				<td><b>Comments</b></td><td colspan="5"><?php echo $this->Form->input('comments',array('label'=>false,'div'=>false));?></td>
			</tr>
			
	</table>
<?php echo $this->Form->end(__('Submit', true));?>

</div>